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On Site Oral Surgery, Wisdom Teeth Extractions

At times, the removal of a wisdom tooth or other tooth may be required. The team at Cityview Dental have the expertise and tools to make the extraction process as comfortable and pain free as possible for you. To learn more about the types of extractions we provide please click one of the links below.

Oral Surgery

By the age of 18, most adults have 32 teeth: 16 teeth on the top and 16 teeth on the bottom. The average mouth is made to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that holds only 28 teeth. These four extra teeth are your third molars, also known as wisdom teeth. These can become problematic.

Why Should I Have My Wisdom Teeth Removed?

Wisdom teeth are the last teeth to erupt within the mouth. When they align properly and gum tissue is healthy, wisdom teeth do not need to be removed. Unfortunately, this does not generally happen. Wisdom tooth extraction is necessary when the teeth are prevented from properly erupting within the mouth. They may grow sideways, partially emerge, or even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to successfully erupt, which can cause many problems. When a tooth partially erupts, the opening around the tooth allows bacteria to grow and will eventually cause an infection, resulting in swelling, stiffness, pain, and illness. The pressure from the erupting wisdom teeth may cause other teeth to move and possibly disrupt the natural or orthodontic alignment of teeth. The most serious problem occurs when tumors or cysts form around the impacted wisdom teeth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending teeth usually resolves these problems. Early removal is recommended to avoid future complications and to decrease the surgical risk involved with the procedure.

Inability to treat a cavity in a tooth without removal of the wisdom tooth

Disease of follicles, i.e. a cyst (a sac filled with fluid) or tumor

Root, bone or crown breakdown to a wisdom tooth

Fracture to a wisdom tooth or neighbouring teeth

If one of these problems is present the following may develop:

Pain or tenderness in the gums or jawbone

Bad breath

Redness or swelling in the gums

An unpleasant taste in the mouth

Headaches or jaw ache

Wisdom Tooth Extraction

If during your appointment we feel it is in your best interest to have your wisdom teeth extracted, we will happily schedule you an additional consultation with our oral surgeon to discuss your options, answer questions and explain any possible surgical risks before the procedure is performed.

Post Wisdom/ Teeth Removal

The removal of impacted teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully. Immediately following surgery:

Directions immediately following surgery:

Bite on the gauze pad placed over the surgical site for an hour. After this time, the gauze pad should be removed and discarded and replaced by another gauze pad. Refer to the section on BLEEDING for more details.

Avoid vigorous mouth rinsing or touching the wound area following surgery. This may initiate bleeding by causing the blood clot that has formed to become dislodged.

To minimize any swelling, place ice packs to the sides of your face where surgery was performed. Refer to the section on SWELLING for explanation.

Take the prescribed pain medications as soon as you can so it is digested before the local anesthetic has worn off. Having something of substance in the stomach to coat the stomach will help minimize nausea from the pain medications. Refer to the section on PAIN for specific details.

Restrict your activities the day of surgery and resume normal activity when you feel comfortable. If you are active, your heart will be beating harder and you can expect excessive bleeding and throbbing from the wound.

NO SMOKING UNDER ANY CIRCUMSTANCES

Bleeding

A certain amount of bleeding is to be expected following surgery. On the skin where the surface is dry, bleeding clots in 10 minutes. In the mouth where things are wet, it takes 6-8 hours for the clot to gel up and the bleeding to subside. Slight bleeding or oozing causing redness in the saliva is very common. For this reason, the gauze will always appear red when it is removed. Saliva washes over the blood clots and dyes the gauze red even after bleeding from the sockets has actually stopped.

First GENTLY rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for sixty minutes, may control excessive bleeding. Repeat as necessary.

If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. This can be repeated several times.

If bleeding does not subside after 6-8 hours, call the office for further instructions (416-368-2855).

Swelling

It is normal to experience swelling of the cheek(s) after the removal of impacted wisdom teeth.The swelling will not become apparent until the day after surgery and will not reach maximum effect until 2-3 days’ post-operation.

The swelling may be minimized by the immediate use of ice packs. Sealed plastic bags filled with ice, ice packs, or a bag of frozen peas or corn wrapped in a washcloth should be applied to the side of the face where surgery was performed.

The ice packs should be applied 20 minutes on/20 minutes off for the afternoon and evening immediately following your extraction. After 24 hours, ice has no beneficial effect.

36 hours after surgery, the application of moist heat such as a warm, damp cloth to the side of the face may help to reduce any swelling that has formed.

If swelling or jaw stiffness persists for several days, there is no cause for alarm. Soft, puffy swelling that you can indent with your finger is very normal after oral surgery.

In the event that the swelling becomes hot to the touch, bright red and rock hard, which does not indent with finger pressure and is enlarging, it may indicate infection. These symptoms would usually develop around day 3-4 after surgery. If this should occur, call our office for support.

Temperature

It is normal to run a low-grade temperature (99°-100°F) for 7-10 days following oral surgery. A high temperature (over 101°F) might exist for 6-8 hours after surgery but should decrease after that time. 2 Tylenol or 2-3 200mg Ibuprofen (Motrin/Advil) every 4-6 hours will help to moderate a temperature.

A temperature above 101°F several days after surgery – especially when accompanied by redness, hard swelling and increased pain – are usually indicative of infection. You should call the office for instructions if this should occur.

Bruising

When the bone requires smoothing to allow for the fit of a denture, some bruising is likely to appear on the surface skin over the area. This most commonly occurs over the upper eye teeth (on the cheek and below the eye).

Bruising may not be obvious for a day or two. By the time it reaches the surface it may have already turned from purple to green to yellow in color. Over several days the yellow color will settle down the neck to about the nipple line on the chest before it disappears.

Pain

Moderate pain or discomfort following surgery is expected to last 4-5 days. For many patients, the third and fourth days may require more pain medicine than the first and second days. Following the fourth day, pain should subside consistently.

Many medications for pain can cause nausea or vomiting. It is wise to have something of substance in the stomach (i.e. yoghurt, ice cream, pudding or apple sauce) before taking prescription pain medicines or over-the-counter pain medicines (especially aspirin or ibuprofen). Pepto Bismol or Milk of Magnesia can also help to prevent or moderate nausea.

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen (Motrin or Advil) two-three 200 mg tablets may be taken every 4-6 hours.

For severe pain take the tablets prescribed for pain as directed every 4 hours in addition to the Tylenol or Ibuprofen. The prescribed pain medicine will make you groggy and will slow down your reflexes.

Do not drive an automobile or work around or operate heavy machinery if you are taking prescription pain medicine.

Alcohol and prescription pain medicines do not mix!

If prescription pain medications are required beyond 4 days, further treatment may be indicated. Please call the office and discuss your situation with us.

Antibiotics

Antibiotics are not routinely given after oral surgery. The overuse of antibiotics leading to the development of resistant bacteria is well documented, so careful consideration is given to each circumstance when deciding whether antibiotics are necessary. Only in specific circumstances will antibiotics be prescribed to help prevent infection or treat an existing infection.

If you have been prescribed antibiotics, take the tablets or liquid as directed. You should take them on schedule until they are completely gone.

In the event of a rash or other unfavorable reaction, discontinue antibiotic use and contact our office to report any such finding.

Diet

Stay hydrated. Try to drink 5-6 glasses of water the first day and don’t use a straw. The sucking motion will dislodge the blood clot that naturally forms in the wound and delay the healing process.

Avoid hot liquids or food until the numbness wears off.

Soft food and liquids can be eaten on the day of surgery. Avoid chewing sharp or hard objects for several days so as not to disturb the surgical site.

Return to a normal diet as soon as you are able, unless otherwise directed. Many people find eating multiple small meals a day is easier than three large meals for the first few days.

Oral Hygiene

Good oral hygiene is essential to proper healing after surgery.

You can brush your teeth the night of surgery, but rinse very gently.

The day after surgery, begin rinsing your mouth with salt water (one cup of warm water mixed with a teaspoon of salt) at least 5-6 times a day, especially after eating.

Mouthwash has an alcohol base so it can cause an unpleasant sensation when it comes in contact with fresh oral wounds. Begin using mouthwash again three days after surgery by diluting the mouthwash by half with tap water. You can gradually build up to full strength mouthwash as the wound becomes less sensitive.

Smoking

Do not smoke for at least 48 hours following surgery. Smoking retards healing dramatically. Nicotine constricts blood vessels, which slows the formation and expansion of the healing blood clot in the socket. This leads to a painful complication called dry socket.

If, 48 hours after surgery, you need so much as one Tylenol or Aspirin to control pain, you should avoid smoking. This usually reflects that the clot has not grown enough to cover all the exposed bone in the socket. The exposed bone is filled with raw nerve endings. Until the nerve endings are covered with a healthy blood clot, they will cause pain. Smoking will slow this process significantly and worsen the pain.

Activity

Keep all physical activity to a minimum for 6-12 hours following surgery. If you are considering exercise beyond this time period, throbbing or bleeding may still occur, in which case you should discontinue all physical activity.

Nausea and Vomiting

If nausea or vomiting persists for more than 12 hours, please call the office for advice

In the event of nausea and/or vomiting following surgery, do not consume anything – including prescribed medicine – for at least one hour. After this period, sip slowly on coke, tea or ginger ale. Avoid milk products.

Coating the stomach with Pepto Bismol or Milk of Magnesiamay help the nausea to subside.

Other Complications

If numbness of the lip, chin or tongue occurs, there is no cause for alarm.This is usually a temporary symptom.

Patients may occasionally feel hard projections in the mouth with their tongue. They are not roots; they are the walls of the tooth socket. These projections usually smooth out in time. You may not notice this for days to weeks after surgery. If the rough edges bother your tongue or cheeks, Dr. Afif or Dr. Poulos can evaluate the area and smooth them down for you.

If the corners of your mouth were stretched during surgery, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline.

Sore throats and pain when swallowing are not uncommon and should subside within 2-3 days.

Stiffness of the jaw muscles may make it difficult to open your mouth for 7-10 days following surgery. This is a common occurrence. Eating, talking, yawning and chewing will help the stiffness to resolve over time.

Pull out all the Stops

When you need a tooth pulled, it’s called an extraction. There are several reasons why a tooth would be extracted instead of repaired:

If the tooth is severely decayed or broken in a way that makes repair difficult or impossible

If gum disease is an issue

If the tooth’s position in the mouth is causing problems to other teeth (e.g. an impacted wisdom tooth can cause inflammation of the gums and allow tartar and plaque to build up)

In preparation for orthodontic treatment

We know that extractions can be stressful and will take every to ensure that your experience, from initial diagnosis to tooth extraction is as painless and stress-free as possible.

We encourage you to share with us any feelings of anxiety about the procedure so that we can take steps to alleviate your discomfort.